Contact: Sonja Giese, Child Health Policy Institute, UCT. Email: [email protected]

Proposed changes to the text in the regulations are indicated as follows:

1. The child support grant is intended as a poverty relief measure, to be used to meet the child’s basic needs such as food, clothing and access to education. The care dependency grant on the other hand is intended to provide additional support to children with a mental or physical disability. Additional expenses may include transport to and from health facilities, assistive devises and compensation to the family for lost income as a result of a parent having to stay at home to care for the child. If a care-dependent child lives in poverty, he or she should therefore be eligible for both the child support grant and care dependency grant.
2. The age of eligibility is a problem. A child is defined as a person under the age of 18 years. All children who live in conditions of poverty should qualify for a child support grant. When a child reaches the age of 7 years, the family incurs additional expenses related to schooling. Without the child support grant, many children are unable to attend school and a viscous cycle of dependency is created. In HIV affected households, the situation is worsened:
• Families may lose one or more breadwinner to AIDS.
• While household income drops, expenditure in HIV affected households has been shown to quadruple with the costs of medication, transport and funerals.
• When a parent is ill, studies have shown that the child’s school attendance drops because labour is needed to subsidise the family income and the family cannot afford to pay school fees.
• In desperation, children turn to crime, prostitution and other forms of child labour as a direct result of economic need.

CHPI calls for the extension of the child support grant to all children under the age of 18 years.

CHPI proposes the amendment of Subregulation 3 (2) (e) and (i)(aa) as follows:

In addition to the requirements of Subregulation (1), a person shall be eligible for a child support grant if -

e) he or she or any other person is not already in receipt of a foster child grant in respect of the child concerned

(i) the child in respect of whom the grant is made, is-

(aa) under the age of seven eighteen years

OR

As an alternative to amending Subregulation 3 (2) (i) (aa), the Minister could exercise his powers in terms of regulation 3(2) (i) (bb) and increase the age of eligibility incrementally through notice in the Government Gazette. The initial increase in age of eligibility should be at least 12 years of age with immediate effect and further increases should follow a fast track timeframe.

Consequential amendments will be needed to bring related regulations (such as Subregulation 24 (2) (c)) in line with the proposed amendments to Subregulation 3 (2) (i).

Regulation 5: Persons eligible for care-dependency grants

As with the child support grant, CHPI calls for the department to develop a strategy to ensure that children orphaned by HIV/AIDS and, in particular, those living in child headed households, are able to access and benefit from the care dependency grant for all children living in the affected household who qualify in terms of Regulation 5. This strategy should be translated into departmental directives and accompanied by the training of personnel and the allocation of the necessary resources.

The department proposes the following amendments to Regulation 5:

1. "A parent or parents or a foster parent or foster parents shall be eligible for a care-dependency grant in respect of a care-dependent child for a maximum amount per annum as approved by the Minister with the concurrence of the Minister of Finance: Provided that the medical report from a medical officer which has been approved by a medical pensions officer shall confirm assessment panel appointed by the Director-General confirms that the child in question is a care-dependent child as defined in the Act and the combined annual income of the family, after all permissible deductions referred to in the regulation 15, shall not exceed R48 000 or such higher amount as the Minister may from time to time determine."
2. Notwithstanding Subregulation (1), the income of a foster parent or foster parents of a care dependent child shall not be taken into consideration.

Comments on amendments to Regulation 5:

1. CHPI supports the concept of an assessment panel to be used to determine an applicant’s eligibility for the grant. The Institute is concerned however that without more detailed information on who will be represented on the panel and how the panel will function, the possibility exists that an assessment panel may create additional administrative delays in processing of grant applications. CHPI therefore calls for the regulations to provide more detail on how the panel will function.
2. Subregulation (1) implicitly excludes the primary caregiver who is not a biological parent or foster parent, from accessing the care dependency grant. Children being cared for informally by extended family or other members of the community and children living in child headed households, will therefore not be eligible for the care dependency grant. In order to access a care dependency grant for an HIV+ child, the caregiver would have to go through the lengthy and expensive process of fostering the child. The cost to the state will be enormous. Not only will the foster parents then be eligible for a foster grant as well as a care dependency grant, but the state will be forced to monitor and renew the child’s placement every two years.
3. Families only qualify for a care dependency grant if the combined annual income of the family, after all permissible deductions, does not exceed R48 000. While the real value of R48 000 is far less than its value four years ago, the amount of R48 000 has not been increased since the 1998 regulations were drafted.
4. While a few children who have been rendered severely physically disabled as a result of AIDS have managed to access the care dependency grant, the regulation does not allow for children who are HIV+ to receive the grant. There are several compelling reasons why children who are HIV+ should qualify for the care dependency grant:
• The majority of infections in children under the age of 12 years is through vertical transmission. The child’s HIV+ status therefore implies that at least one of his/her parents is also HIV+. The impact on the family of a child’s HIV+ diagnosis is therefore far reaching.
• Because of the stigma surrounding AIDS and the fear of the ramifications of disclosure, it is not uncommon for the family breadwinner to abandon the family when a child is found to be HIV+. The affected household is therefore thrown into financial turmoil.
• HIV disease progression in children is quicker than that of adults, but the child’s prognosis may be vastly improved with appropriate socio-economic support and improved nutritional status. By ensuring that children up to the age of 12 years who are HIV+ have access to the care dependency grant, the state would be providing the child’s caregiver with the means necessary to meet the special nutritional and health needs of the child, improving the child’s health status, quality of life and life expectancy. This will most likely impact on the number and duration of HIV related paediatric hospital admissions and reduce health expenditure.

CHPI proposes the following additional amendments to Regulation 5 and the insertion of Subregulation 5 (3):

(1)"A parent or parents primary caregiver or a foster parent or foster parents shall be eligible for a care-dependency grant in respect of a care-dependent child …

(3) The Minister may include in the definition of "care dependent child", other groups of children who are eligible for the care dependency grant, by publication of a notice in the government gazette.

CHPI proposes that the Minister exercise his authority in respect of the proposed Subregulation (3) immediately and publish a notice in the government gazette that HIV+ children up to and including 12 years of age be eligible for the care dependency grant on diagnosis. The age of eligibility should then be increased incrementally over a fast track timeframe.

CHPI further proposes that the Minister exercise his authority in respect of Subregulation 5 (1) and increase the means test threshold amount of R48 000 to a market related figure, taking into account the increased cost of living.

Consequential amendments will be needed to bring related regulations (such as Regulation 8 (2) (b) and Regulation 22) in line with the proposed amendments to Regulation 5 (1).

Regulation 9: Documents to accompany applications for grants

Subregulation 9 (1)

Subregulation 9 (1) stipulates that the applicant’s identity document and, where applicable, the identity document of his or her spouse, together with the child’s identity document or birth certificate bearing a 13 digit identity number, accompany a grant application. This is problematic for a number of reasons:

• Home affairs offices are not available in many, particularly rural, areas and many families cannot afford to travel to the nearest home affairs office to apply for a birth certificate or identity document. As a result of this and other issues, 51 % of children do not have birth certificates.
• Many children abandoned or orphaned as a result of AIDS have little or no information on their parents or their date or place of birth.
• Once an application has been made for an identity document, it can take weeks for the application to be processed.
• Once the identity document or birth certificate has been obtained, the caregiver then begins the lengthy process of applying for a grant. This can take several months.

The process of applying for and obtaining identity documents and the grant can be expensive and time consuming. During this process, the caregiver may have little or no income.

The HIV/AIDS pandemic is creating hundreds of thousands of vulnerable and destitute children:

• By 2011, South Africa will have an estimated 3 000 000 orphans.
• Between 1996 and 1999, the National Child Council for Child Welfare reported a 67% increase in the number of abandoned children in South Africa.
• Large numbers of children are being abandoned in hospitals around the country.

There is therefore a need to simplify the procedures and requirements for accessing social assistance so that these children may be cared for.

CHPI proposes the following

CHPI proposes that an amendment is made to regulation 9 to allow for the grant application to be processed with interim proof of identity (such as a clinic card, sworn affidavit or receipt of application of an identity document). The proviso could state that the birth certificate or 13 digit identity number be provided within 6 months of the date of application of the grant. Any delay in obtaining documents which is due to inefficiencies on the part of the Department of Home Affairs should in no way prejudice an applicant.

In the alternative to an amendment, the Director0General can issue a general directive in terms of regulation 9(7) that interim proof of a child's identity will be accepted for an application for a children's grant, provided that the formal proof is handed in within 6 months of the application.

Regulation 11: Date of accrual of grants

The department has proposed the following amendments to Subregulation 11 (1):

"The date of accrual of the grant shall be the date on which the Director-General approves the application for the grant in terms of regulations 25 (1): Provided that a grant shall not accrue for a period exceeding three months form the date of approval of the grant the application is deemed to have been made in terms of regulation 10(1)"

Comments on proposed amendment:

CHPI supports the proposed amendment of Subregulation (1).

Regulation 14: Determining income in respect of social grants, foster child grants, care-dependency grants and child support grants.

Subregulation 14 (1)

The department proposed the insertion of Subregulation (1) (j) which reads as follows:

(j) "Notwithstanding the provisions of paragraphs (a) to (i) of Subregulation (1), the income from social assistance shall not be taken into consideration."

Comments on proposed amendment:

CHPI supports the insertion of Subregulation (1) (j).

Regulation 16: Determining the financial criteria for a child support grant

Subregulation 16 (1)

Subregulation (1) provides the Minister, in concurrence with the Minister of Finance, with the authority to increase the amount of the child support grant.

Comments on Subregulation 16 (1)

The amount of the child support grant will be increasing from R100 per month per child under the age of 7 years, to R110 per month as from July 2001. This amount is not sufficient to meet the basic needs of a child and should be reviewed in terms of objective poverty measures.

CHPI proposes:

CHPI recommends that the Minister, in concurrence with the Minister of Finance, exercise his powers in terms of Subregulation 16(1) and place a notice in the government gazette increasing the amount of the Child Support Grant to at least R200 per month per child with immediate effect, with the commitment to increase this amount on an annual basis, in line with inflation.

Subregulation 16 (2)

Subregulation 16 (2) currently states:

A primary care giver shall qualify for the amount referred to in Subregulation (1) if- his or her personal income is below-

1. R9600 per annum; or
2. R13200 per annum and the child concerned and his or her primary caregiver either-

(aa) live in a rural area; or

(bb) live in an informal dwelling

Comments on Subregulation 16 (2)

The means test which disqualifies a primary care giver (and spouse) from earning above a stipulated amount per annum, is problematic:

• The means test is time consuming and costly to maintain.
• Between 60 and 70 % of children in South Africa live in poverty. The cost of excluding families who are not eligible is therefore not worth the amount saved as a result of paying out fewer grants.
• The means test has also created opportunities for corruption among officials responsible for processing grant applications.
• The administrative difficulties that are associated with the means test discourage many families who live in extreme poverty from applying for the grant.
• Because the personal income of the primary caregiver (which, according to the definition of "personal income" includes the income of the primary caregiver’s spouse) has to be below the threshold amount of R9600 / R13200 per annum, those families who are receiving the grant are discouraged from seeking employment that might disqualify them.
• The amount of R9600 / R13200 per annum has not been increased since 1998 while in real terms the buying power of this amount has decreased substantially.
• The threshold income of R9600 / R13200 per annum also fails to take into consideration the number of children living in the care of the primary care giver. With increased mortality of relatively young individuals as a direct result of AIDS, the structure of the age pyramid is expected to change. As a result, we will be left with fewer breadwinners and caregivers providing for the needs of children. It is therefore imperative that if a means test is used to determine eligibility, it takes into account the number of children cared for by the primary caregiver.

CHPI proposes the following new amendments to Subregulation 16 (2)

CHPI proposes that the means test for the child support grant be abolished and that the grant be universally accessible.

OR

If this recommendation is not taken up, CHPI calls for the following urgent amendments to the means test and the processing of child support grants:

1. The threshold income should be increased to an amount greater than R9600 / R13200 per annum. The threshold income should be determined using an objective poverty measure and should be increased annually in line with inflation.
2. The means test should include some reference to the number of children being provided for on the personal income of the primary caregiver. A formula would need to be worked out to calculate the cost of care per additional child.
3. The process of applying for the child support grant should be simplified and made more accessible to people living in rural areas.
4. Applications for the child support grant should be fast tracked for households with no income, such as households where the breadwinners have died of AIDS.

Regulation 24: Lapsing of grants

CHPI proposes new amendments to Subregulations 24 (2), (4) and (6)

Subregulation 24 (2)

Subregulation 24 (2) (a) to (c) currently reads as follows:

A child support grant shall lapse-

1. on the last day of the month in which the primary caregiver dies;
2. on the last day of the month in which the child in respect of whom the grant is paid dies;
3. on the last day of the month in which the child in respect of whom the grant is paid attains the age of 7 years;

Comments on Subregulation 24 (2) (a)

HIV/AIDS attacks and kills breadwinners and caregivers within affected households. When a caregiver dies of AIDS, the impact on the child is emotionally, physically and financially devastating. It therefore makes no sense that the child support grant, potentially the child’s only remaining source of income, should lapse when the caregiver dies.

CHPI proposes the following:

The child support grant should follow the child and should continue for as long as the child requires financial assistance from the state. When the primary caregiver dies, the grant should continue to be issued to the child, if appropriate, or should accumulate until such time as an appropriate caregiver has been found to collect the grant on behalf of the child. Mechanisms will need to be put in place to ensure that the child continues to benefit from the grant after the death of his/her primary caregiver.

CHPI therefore proposes the deletion of Subregulation 24 (2) (a)

Comments on Subregulation 24 (2) (b)

One of the major expenses in HIV affected households is that of funeral costs. Families caring for HIV+ children also incur additional expenses when the child reaches the terminal stages of disease. At this stage, the caregiver may be required to stay at home to care for the child and the child may require additional medication or more frequent visits to hospital. While the grants provide no additional support at this stage, some of the costs could be covered if the state were to continue to pay the grant for one month after the death of the child.

CHPI proposes the following new amendment to Subregulation 24 (2) (b)

A child support grant shall lapse-

2. on the last day of the month after the month in which the child in respect of whom the grant is paid dies;

Comments on Subregulation 24 (2) (c)

As discussed in respect of Regulation 3, CHPI calls for the extension of the child support grant to all children under the age of 18 years.

CHPI proposes the following amendment to Subregulation (2) (c)

A child support grant shall lapse-

3. on the last day of the month in which the child in respect of whom the grant is paid attains the age of 7 eighteen years;

 

Subregulation 24 (4)

Subregulation 24 (4) (a) and (b) currently reads as follows:

A care-dependency grant shall lapse-

1. on the last day of the month in which the parent or foster parent dies;
2. on the last day of the month in which the care-dependent child dies

Comments on Subregulation 24 (4)

As with Subregulation 24 (2) (a) and (b) discussed above.

CHPI proposes the deletion of Subregulation (4)(a) and the following amendment to Subregulation (4)(b)

A care-dependency grant shall lapse-

(b) on the last day of the month after the month in which the care-dependent child dies

Subregulation 24 (6)

The amendments propose that Subregulation 24 (6) be deleted. Subregulation 24 (6) states that:

The Director-General shall pay a social grant, a foster child grant or a care-dependency grant until the last day of the month in which the beneficiary or the child dies, as part of the payment of expenses incurred in respect of the care or funeral of the beneficiary or child on submission of documentary proof by the person liable for the expenses: Provided that an application shall be made within six months after the death and the amount shall not exceed the amount owing to the beneficiary at the time of death.

Comments on proposed deletion of Subregulation (6)

As mentioned above, financial support for burial costs is essential and removing Subregulation (6) would be retrogressive, especially in light of the increasing infant and child mortality rates due to HIV/AIDS.

CHPI proposes that Subregulation (6) remain and be amended as follows:

The Director-General shall pay a social grant, a child support grant, a foster child grant or a care-dependency grant until the last day of the month after the month in which the beneficiary or the child dies, as part of the payment of expenses incurred in respect of the care or funeral of the beneficiary or child on submission of documentary proof by the person liable for the expenses: Provided that an application shall be made within six months after the death and the amount shall not exceed the amount owing to the beneficiary at the time of death.

Regulation 25: Notification of approval or refusal of a grant and of right to appeal

Subregulation 25 (1)

Subregulation 25 (1) currently states:

"The Director-General shall if he or she approves an application for a grant, inform the applicant in writing of such approval and the date on which approval was granted."

Comments on Subregulation 25 (1):

The regulations give no indication as to the time frame in which an applicant will be given a response. For many families affected by HIV/AIDS the grant may be the only source of income and the household will have invested resources into acquiring the necessary documents and making the application. Many applicants wait for an unacceptable length of time for their application to be processed with no accessible recourse to the department.

HIV affected families often only get to know of and apply for a grant once they find out that the primary caregiver or main breadwinner is HIV+. The lengthy processing of grant applications usually means that the child/caregiver lacks support during a very critical phase of the HIV infection.

In the case of the disability grant, adults are only able to apply for the grant at a late stage of HIV disease progression. By the time the grant is processed it offers little assistance in preventing the deterioration of the caregiver’s health.

CHPI proposes the following insertion in Subregulation 25 (1):

The Director-General shall if he or she approves an application for a grant, inform the applicant in writing of such approval and the date on which approval was granted. This shall be done within 3 months of the date on which application is deemed to have been made in terms of regulation 10.

Regulation 26: Persons eligible for social relief of distress

Subregulation 26(1)

The department proposes the following amendments to Subregulation 26 (1) (a) and the insertion of Subregulation 26 (1) (f)

Subject to the provisions of the Act, a person in need of temporary material assistance may qualify for social relief of distress if he or she complies with one or more of the following conditions.

1. The person is awaiting permanent aid; awaiting approval of his or her grant

(c)The breadwinner is deceased and insufficient means are available

(f) the person has appealed the rejection or the suspension of his or her grant

Comments on Subregulation 26 (1)

CHPI recommends that the word "may" be replaced with the word "shall" in sub-regulation (1).

Re-draft: "26(1) subject to the provisions of this Act, a person in need of temporary material assistance may shall qualify for social relief of distress if he or she complies with one or more of the following conditions: "

CHPI supports the insertion of Subregulation 26 (1) (f).

However, CHPI calls for more clarity on what is meant by "insufficient means" as mentioned in Subregulation (1) (c). This is particularly relevant to families affected by HIV/AIDS where the death of the breadwinner is common.

Recommendations for further amendments to Regulation 26

Many grant applicants are not aware that they may apply for a social relief of distress grant while awaiting the processing of their application for the Child Support Grant, Care Dependency Grant or Foster Child Grant. This lack of awareness is partly due to the relevant welfare official not informing the applicant of this possibility.

CHPI therefore recommends that a sub-regulation be inserted in Regulation 26 specifying that the welfare official must be obliged to inform the applicant that they can apply for a social relief of distress grant while they are waiting for their permanent grant to be processed.

Re-draft: Insert 26 (4). " When an applicant applies for a social grant, child support grant, care dependency grant or foster child grant, the attesting officer (officer to whom the applicant hands the application) shall inform the applicant that he or she may apply for a social relief of distress grant while awaiting approval of their application."

 

Regulation 27: Application for social relief of distress

Subregulation 27 (6)

The department proposes the deletion of Subregulation 27 (6) (c) and (d) which state that the application of social relief shall be accompanied by the following documents:

(c) proof of non-payment of maintenance

(d) proof that spouse cannot be traced

Comments on proposed amendments to Subregulation 27 (6):

CHPI supports the deletion of Subregulations 27 (6) (c) and (d).

Regulation 29: Determination of the amount and the period of social relief of distress

Subregulation 29 (1)

Subregulation 29(1) currently states:

Subregulation 29 (1) (c) states that subject to the provisions of the Act, the value of social relief of distress shall be equal to-

(c)in the case of a child, an amount not exceeding the maximum child support grant payable per month

Comment on Subregulation 29 (1) (c):

In the case of a child who is in the symptomatic phases of HIV disease (ie the child is starting to get sick as a result of the impact of HIV on his/her immune system), the caregiver may require additional means in order to provide for the special needs of the child. If the caregiver is waiting for a permanent grant application to be processed, the maximum amount of social relief payable should be the amount payable for the care dependency grant (R570) as opposed to the amount payable for the child support grant (R110).

CHPI proposes the following new amendment to Subregulation 29 (1)(c):

Subject to the provisions of the Act, the value of social relief of distress shall be equal to-

(c)in the case of a child, an amount not exceeding the maximum child support grant care dependency grant payable per month

Subregulation 29 (2)

The department proposed the following amendments to Subregulation 29 (2):

"Social relief of distress shall be issued monthly by the Director-General or a person assigned by him or her for a maximum of three continuous months period of four consecutive months within a year calculated as from the date of application".

Comments on proposed amendments to Subregulation (2)

CHPI welcomes the extension of the period of the social relief grant.

However, applications for the CSG, CDG and FCG on average take more than 4 months to be approved. If the applicants social relief of distress grant expires after four months, the applicant will be without a safety net for the period in between the expiry of the social relief of distress grant and the approval of the relevant permanent grant. This period of time could be lengthy.

CHPI therefore recommends that Regulation 29 (2) should be amended to provide that a person awaiting final approval of his or her application for a grant is entitled to the social relief of distress grant up until the date that the permanent grant becomes available. Besides ensuring that the applicant is fully provided for while waiting for his or her grant, such a system will provide an incentive to the Department to process applications speedily to avoid having to pay social relief of distress grants to unsuccessful applicants for long periods of time. If the applicant is awarded a permanent grant, the amount paid in respect of social relief may then be recovered from the arrear payments in respect of the grant.

 

 

 

Re-draft: 29 (2)

1. Social relief of distress shall be issued monthly by the Director-General or a person assigned by him or her for a maximum period of 4 consecutive months.
2. Notwithstanding sub-regulation (a), social relief of distress shall be issued monthly to a person awaiting approval of his or her grant until the last day of the month in which the Director General informs the applicant of the approval or refusal of his or her application in terms of regulation 25.

Subregulation 29 (3)

The department proposed deleting Subregulation 29 (3) which states that:

Notwithstanding the provisions of Subregulation 29 (2), the Director-General may, in exceptional cases, approve the extension of the period by a further three months.

Comment on proposed deletion of Subregulation 29 (3)

The time taken to process a grant application may exceed 4 months. If our suggestion with regards to inserting subregulation 29(2) (b) is not heeded, CHPI proposes that Subregulation 29 (3) not be deleted as it serves a vital function in providing desperate families with some form of assistance if the processing of their grant application is delayed.

Subregulation 29 (5)

The department proposed the deletion of Subregulation 29 (5) which states that:

(5) The Director-General may, in exceptional cases, approve transport expenditure where-

1. an applicant is referred for treatment by a medical officer and no other arrangements can be made for transport; or
2. an applicant must travel to a specific destination to assume employment where he or she will no be dependent on further State aid.

Comments on proposed deletion of Subregulation 29 (5):

Lack of access to transport has repeatedly been cited as a major stumbling block to accessing support and services. CHPI therefore proposes that Subregulations 29 (5) (a) and (b) not be deleted but rather that practical steps be taken to ensure the accessibility of these forms of social relief.

Additional recommendations for administration of social relief of distress

Social relief of distress offers emergency assistance to desperate families. CHPI therefore proposes that the processing of social relief be decentralised so as to ensure rapid processing and administration and to avoid the lengthy waiting period characteristic of the other grants.

Mechanisms are needed to ensure that families who qualify for social relief of distress are able to access the funds. In line with this, there is a need to raise community awareness on what is available through social relief of distress, and to inform welfare offices of the availability of such support.

CONCLUSION

The Child Health Policy Institute would like to thank you for the opportunity to submit our recommendations and to wish you well in the finalizations of the regulations. We hope to be provided the opportunity to present our submission to the relevant Parliamentary Portfolio Committees at a later stage in the deliberation process.

Appendix 1

The impact of HIV/AIDS on children in South Africa

South Africa has a population of over 43 000 000, of which 17 000 000 are children. Approximately 60-70% of children in South Africa live in poverty and research suggests that this number is increasing, at least partly as a result of the HIV/AIDS pandemic. The burden of poverty is one of the biggest problems that children infected / affected by HIV/AIDS face, with hunger and denied access to schooling being the primary related concerns among HIV affected youth.

According to the latest antenatal survey, 24.5 % of pregnant women attending public health facilities were infected with HIV at the end of 2000 . An unborn child in South Africa therefore has a 1 in 4 chance of having a mother who is HIV+. Extrapolating these figures for the general population, projections of the number of infected people in South Africa has risen to 4.7 million. Of these, over half are between the ages of 15-24 years.

A total of between 5 and 6 million South Africans are expected to die of AIDS by 2010, leaving an unprecedented number of orphans . Life expectancy at birth by the year 2020 for South Africa will be forty years of age. With increased mortality of relatively young individuals, the structure of the age pyramid is expected to change with fewer breadwinners and caregivers providing for the needs of children.

The impact of HIV/AIDS is greatest on 3 particularly vulnerable groups of children, namely:

1. Children living in households where one or more family member is HIV+
2. Children orphaned by HIV/AIDS
3. Children who are HIV+

Children living in HIV-infected households

By 2011, 56% of the population will live in households where at least one person is HIV-positive or has died of AIDS. The burden of caring for the sick and destitute will also have an impact on the 44% of "uninfected" households.

At the household level, the impact of HIV/AIDS on children is exacerbated by the fact that HIV usually strikes more than 1 member of an infected household and this usually includes the primary caregiver and / or breadwinner. The diagnosis of HIV in a family member often has an immediate and profound socio-economic impact. It is not uncommon for example for the father to abandon the family when the child / mother’s status is disclosed. If the father was the primary breadwinner, the family is thrown into financial crisis and it is at this late stage that help is sought from the state.

When a family member has AIDS, the average household income may fall by between 52 and 67 % while expenditure quadruples with the costs of special medical treatment, transport to health facilities, nutritional requirements and ultimately, funeral costs. The financial impact of an AIDS related death on the average family is 30% greater than the financial impact of any other cause of death.

The financial burden of HIV/AIDS adversely affects the living standards and quality of life of all household members, leading to food insecurity, malnutrition, poor hygiene, loss of opportunity and other factors related to poverty.

With competing priorities for limited resources, children in infected households are often unable to afford school uniforms, school fees and books which are a prerequisite for school attendance. The combined socio-economic consequences of HIV/AIDS on children in infected households is far reaching, with reduced opportunity for growth and development creating a cycle of dependency, vulnerability and abuse.

Children orphaned by AIDS

South Africa already has approximately 300 000 maternal AIDS orphans under the age of 15 years, yet the ‘orphan epidemic’ is still in its infancy and by 2011, this figure is expected to increase to as much as 3 million. In most parts of the industrialized world, no more than 1% of the child population is orphaned. In developing countries this figure was around 2.5% before the HIV/AIDS pandemic. If one combines all other causes of maternal death with the HIV/AIDS pandemic, 11% of children under the age of 15 years in South Africa are orphans and this figure is expected to rise to almost 17% by 2010. BY 2015, AIDS orphans will constitute between 9 and 12% of South Africa’s total population.

Children who have been orphaned are more likely than their peers to be malnourished, sick, abused and sexually exploited. They are at greater risk of dying from preventable diseases and are less likely than other children to be fully immunised. With limited resources and inadequate adult supervision, orphans are more likely to drop out of school , leaving them with fewer opportunities for growth and development. They are also denied the benefit of the monitoring and support of teachers and peers and the nutritional support offered through the primary school nutrition programme.

As a result of the stigma and discrimination surrounding AIDS and the devastating socio-economic consequences of the virus, children orphaned by HIV/AIDS are at greater risk than other orphans .

Children infected with HIV

There are at present at least 120 000 children under the age of 13 years who are infected with HIV.

Children infected with HIV live in affected households and for many of these children, one or more of their parents will also be HIV+. All the stresses and socio-economic consequences of living in an HIV affected household therefore apply to these children in addition to the burden of HIV infection.

The majority of HIV infected children under the age of 13 years acquire HIV in one of the following ways:

1. From their infected mothers during pregnancy,
2. at the time of delivery or,
3. after birth, through breastfeeding.

Over 105 000 babies will be born HIV+ this year. In children, the period of time between infection and mortality is less than the same interval in adultsand 60% of these children will not live beyond their 5th birthday. 40% of them will live beyond the age of 5 years and the majority of these children will join the 60-70 % of children in South Africa who live in conditions of extreme poverty. An HIV+ child’s prognosis is dependent on a number of factors, including socio-economic conditions and nutritional status. These factors make it imperative that young children who are diagnosed as HIV+ receive the financial and material support necessary to sustain their health and improve their quality of life.

Existing social security for children infected / affected by HIV/AIDS

While no specific social security provisions are in place for children affected by HIV/AIDS, the existing legislation provides some financial support to these children, primarily in the form of the child support grant or foster child grant. Financial and administrative planning of these grants has however not taken into account the impact of HIV/AIDS on the demand for social security. For children who are HIV+, no additional support is available although the care dependency grant provides a possible mechanism through which such support may be offered.

Child support grant (CSG)

The child support grant is targeted at poor children between the ages of 0 to 6 years. The amount of R100 per month (increasing to R110 in July 2001) per child is provided, subject to a means test based on the personal income of the caregiver.

The grant is being phased in over a period of 5 years, between 1998 and 2003, with the target being 3 million children. The target was based on estimates of the number of children living in poverty in South Africa and does not take into account the impact of HIV/AIDS. Other estimates of the number of 0 to 6 years olds who qualify for the grant in terms of the means test are as high as double the department’s figure of 3 million. The target of 3 million set by the department is used to determine the budget allocated to the grant. In spite of this, national and provincial statistics reveal that the budgetary allocations for the CSG do not match the projected targets. In Kwazulu-Natal for example, the provincial budget for the CSG was exceeded even though they only had a take up rate of 53% of the targeted number of children. If the budget for child and family grants is not substantially increased many children and families will be turned away.

The means test for accessing the CSG discriminates against larger households by not taking into consideration the number of children living in a household. As a result, families may be discouraged from taking in AIDS orphans. Furthermore, the grant is only payable in respect of a maximum of 6 children per household. The grant therefore does not offer much assistance to families/grandparents caring for large numbers of young children.

The current uptake of the CSG is, at best, 33% of the targeted 3 million. This is due in part to the difficulty in accessing the grant. Administrative delays in processing grant applications, poor attitude of administrative personnel, lack of knowledge of the available grants among communities, shortage of grant application offices in rural areas, together with the fact that 51% of children do not have birth certificates, means that, for many families living in desperate poverty, the child support grant is not accessible.

Foster child grant (FCG)

For children who have been formally placed in the care of foster parents, through a children’s court, a foster grant (R390, increasing to R410 in July 2001) is available. The amount of the foster grant is almost 4 times greater than the child support grant, thereby providing a disproportionate amount of support to caregivers who are not the biological parents of the child, and to the small minority of alternative caregivers who have gone through the lengthy process of formal fostering. There are at present 62 000 children in foster care in South Africa. With an estimated 300 000 AIDS orphans in South Africa today, and an expected 2.7 million more within the next 10 years, we can expect the demand on the foster care system to increase 10 fold.

While service providers warn of the impending crisis in the child and youth care system, the current formula for provincial budgetary planning does not include reference to the foster child grant. Provincial welfare budget allocations are calculated on the basis of the old age pension, disability grant and child support grant (i.e. children aged 0 to 6 years) . The government therefore appears to be basing its budgetary planning on the assumption that caregivers of AIDS orphans will not be applying for the FCG.

Unless the amount of the child support grant is brought more in line with the amount of the foster child grant and other mechanisms are put in place to support families caring for AIDS orphans, the financial incentive to apply for the foster child grant will be great and the government’s assumption could be grossly inaccurate.

Care dependency grant (CDG)

Children in South Africa with severe disabilities are eligible for a care dependency grant (R540 per month, increasing to R570 in July 2001). A few children in the terminal stages of AIDS have managed to access this grant but no formal policy exists to guide practitioners on whether and when HIV+ children may be awarded this grant.

Approximately 1/4 of children orphaned by AIDS will themselves be HIV+. It will be extremely difficult to find families to care for these children, particularly if no financial assistance is provided to these families to help them to meet the special needs of an HIV infected child.